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Wong JS, Zhong S, Liu H. Relationship Quality Change Among Partnered Older Adults During the COVID-19 Pandemic. J Gerontol B Psychol Sci Soc Sci 2023; 78:352-358. [PMID: 36124955 PMCID: PMC9938919 DOI: 10.1093/geronb/gbac140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic dramatically changed social life, but we know less about whether partnered relationships changed during this time. Because high-quality intimate relationships are key to many older Americans' well-being, we explore whether, how, and for whom the pandemic changed relationship quality among partnered older Americans. METHODS Nationally representative data from 1,642 partnered adults aged 50 and older come from the 2020 National Social Life, Health, and Aging Project COVID-19 Study. Multinomial logistic regression analyses estimate the likelihood of reporting improved, unchanged, or worsened relationship quality since the pandemic began across sociodemographic groups. RESULTS Two thirds of respondents reported that relationship quality stayed the same during the pandemic, 22.8% reported their relationship quality got better, and 10.5% reported their relationship quality got worse. Although women and the oldest old were less likely to report improved relationship quality, Black respondents were more likely to do so, even after controlling for explanatory variables. DISCUSSION Resilience describes many partnered older adults' experiences during the first year of the pandemic, suggesting that they were able to protect their partnerships during this public health crisis.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia, South Carolina, USA
| | - Selena Zhong
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
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Wong JS, Howe MJK, Breslau H, Wroblewski KE, McSorley VE, Waite LJ. Elder Mistreatment Methods and Measures in Round 3 of the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci 2021; 76:S287-S298. [PMID: 34918146 PMCID: PMC8678432 DOI: 10.1093/geronb/gbab106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elder mistreatment has negative consequences for older adults' health and well-being. As such, scholars aim to understand its causes, the contexts in which it occurs, how to prevent victimization, and how to design interventions for mistreated older adults. This paper provides a detailed overview of the 2015-2016 National Social Life, Health, and Aging Project (NSHAP) Round 3 Elder Mistreatment Module (EMM) to encourage further research on the topic. METHOD This paper reviews previous elder mistreatment scholarship, describes the EMM, provides descriptive analyses of elder mistreatment among community-dwelling older adults, and discusses promising approaches and limitations to future research with these data. RESULTS The EMM includes 10 stem questions to measure elder mistreatment behaviors experienced since age 60 and 2 follow-up questions about perceived severity and the identity of the perpetrator. The stem questions can be analyzed individually or combined into a scale, and researchers can account for severity as a robustness check. Analysts can also group the measures into specific types of elder mistreatment. A major strength of the EMM is its ability to identify perpetrators in victims' core social networks. DISCUSSION The NSHAP Round 3 EMM provides scholars an opportunity to study older Americans' mistreatment experiences, particularly as they relate to their physical and mental health, their social networks and personal relationships, and their broader social contexts.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia, USA
| | - Melissa J K Howe
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
| | - Hannah Breslau
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
| | | | - V Eloesa McSorley
- Rush University Medical Center, Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Linda J Waite
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
- Department of Sociology, University of Chicago, Illinois, USA
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Wong JS, Hsieh N. Couple Analysis in the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci 2021; 76:S276-S286. [PMID: 34918155 PMCID: PMC8678438 DOI: 10.1093/geronb/gbab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Marital and intimate partner relationships are some of the most important social ties that shape older adults' health and well-being. This paper provides analytic guidelines for the couple data in Round 2 (2010-2011) and Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) to encourage more research on marriage and partnership in late life. METHOD First, we describe the recruitment of couples and outline how to identify partners in the data sets. Second, we provide descriptive information about the couple sample. Third, we offer guidance for analyzing the dyadic data cross-sectionally and longitudinally. RESULTS Round 2 interviewed all primary respondents and a sample of their current cohabiting partners and spouses (n = 955 couples). In Round 3, NSHAP reinterviewed the primary respondents and partners who participated in Round 2 (Cohort 1; n = 621 couples) and recruited a new sample of age-eligible adults along with any cohabiting romantic partners (Cohort 2; n = 766 couples). Couples can be identified using a household ID variable in Round 2 and a partner ID variable in Round 3. Demographic characteristics of the couple sample vary by round and cohort. DISCUSSION Researchers can use data from either round to conduct cross-sectional dyadic analyses to examine issues faced by older couples. A common strategy for couple analysis is the actor-partner interdependence model. With 2 rounds of couple-level data, researchers may consider using cross-lagged models in their research.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia, USA
| | - Ning Hsieh
- Department of Sociology, Michigan State University, East Lansing, USA
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Yang EZ, Kotwal AA, Lisha NE, Wong JS, Huang AJ. Formal and informal social participation and elder mistreatment in a national sample of older adults. J Am Geriatr Soc 2021; 69:2579-2590. [PMID: 34105769 DOI: 10.1111/jgs.17282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment. DESIGN Cross-sectional analysis. SETTING/PARTICIPANTS National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white). MEASUREMENTS Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity. RESULTS Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women. CONCLUSION In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.
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Affiliation(s)
- Emmy Z Yang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nadra E Lisha
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia, South Carolina, USA
| | - Alison J Huang
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Wong JS, Breslau H, McSorley VE, Wroblewski KE, Howe MJK, Waite LJ. The Social Relationship Context of Elder Mistreatment. Gerontologist 2021; 60:1029-1039. [PMID: 31688922 DOI: 10.1093/geront/gnz154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Elder mistreatment victims at risk of poor physical and psychological health may benefit from increased social support. This article identifies mistreatment victims among community-dwelling older Americans and maps their social networks to guide the design of social support interventions. RESEARCH DESIGN AND METHODS Using nationally representative survey data from Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (N = 2,334) and descriptive, latent class, and regression analyses, we estimate the prevalence of mistreatment since age 60, identify the alleged perpetrators' relationships to the victims, and examine victims' social networks. RESULTS Self-reported lifetime prevalence of elder mistreatment is as high as 21%, depending on the mistreatment behavior measured. Latent class analysis reveals two mistreatment classes: 12% of older adults experienced multiple types of mistreatment (polyvictimization), and 6% experienced primarily financial mistreatment. Although alleged perpetrators are unlikely to appear in older adults' core social networks, the most commonly reported perpetrators are children and relatives. Regression analyses show that experiencing mistreatment since age 60 is associated with having less current social support, more social strain, and fewer kin in the core social network. Older adults reporting polyvictimization also have less-dense core networks. DISCUSSION AND IMPLICATIONS Increasing family support should be done cautiously because children and relatives are frequently named as mistreatment perpetrators. Increasing communication across polyvictimization victims' network members may support their well-being. Providing outside assistance with financial management could benefit financial mistreatment victims.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia
| | - Hannah Breslau
- Academic Research Centers, NORC at the University of Chicago, Illinois
| | | | | | - Melissa J K Howe
- Academic Research Centers, NORC at the University of Chicago, Illinois
| | - Linda J Waite
- Department of Sociology, University of Chicago, Illinois
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Hsieh N, Wong JS. Social Networks in Later Life: Similarities and Differences between Sexual-Minority and Heterosexual Older Adults. Socius 2020; 6:237802312097773. [PMID: 33768156 PMCID: PMC7990387 DOI: 10.1177/2378023120977731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Community-based research suggests that lesbian, gay and bisexual (LGB) older adults are more socially isolated than their heterosexual counterparts. However, little is known about how social networks in late adulthood differ between LGB and heterosexual people at the population level. Using data from the 2015-16 National Social Life, Health and Aging Project (N=3,929), we compare the size, frequency of contact, composition, diversity, and density of core discussion networks as well as family and friend support across sexual orientation groups. We find that LGB people share a few network characteristics with their heterosexual counterparts, including network size, frequency of contact with network members, and proportion of non-spousal kin members in the network. However, their networks are less likely to include an intimate partner, are more likely to include friends, and have lower diversity and density. LGB people also report lower family support but higher friend support than heterosexual people.
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Affiliation(s)
- Ning Hsieh
- Department of Sociology, Michigan State University
| | - Jaclyn S Wong
- Department of Sociology, University of South Carolina
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Wong JS, Waite LJ. Response to Acierno's comments on Wong and Waite, "Elder mistreatment predicts later physical and psychological health: Results from a national longitudinal study". J Elder Abuse Negl 2019; 29:188-190. [PMID: 28398142 DOI: 10.1080/08946566.2017.1317612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We respond to Dr. Acierno's concerns about the measurement of elder mistreatment and social support in the National Social Life, Health, and Aging Project. We made our analytic decisions carefully and conducted systematic robustness checks and believe our findings are theoretically important.
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Affiliation(s)
- Jaclyn S Wong
- a Department of Sociology , University of Chicago , Chicago , Illinois , USA.,b NORC at the University of Chicago , Chicago , Illinois , USA
| | - Linda J Waite
- a Department of Sociology , University of Chicago , Chicago , Illinois , USA.,b NORC at the University of Chicago , Chicago , Illinois , USA
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Wong JS, Hsieh N. Functional Status, Cognition, and Social Relationships in Dyadic Perspective. J Gerontol B Psychol Sci Soc Sci 2019; 74:703-714. [PMID: 28369622 PMCID: PMC6460338 DOI: 10.1093/geronb/gbx024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/15/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Health limitations can change older adults' social relationships and social engagement. Yet, researchers rarely examine how the disability of one's spouse might affect one's social relationships, even though such life strains are often experienced as a couple. This study investigates the association between functional and cognitive limitations and social experience in a dyadic context. METHOD We use actor-partner interdependence models to analyze the partner data from 953 heterosexual couples in Wave II (2010-2011) of the National Social Life, Health, and Aging Project. RESULTS One spouse's functional and cognitive health is associated with the other's relationship quality, but the pattern varies by gender. Husbands' functional limitations are associated with lower marital support and higher marital strain in wives, but wives' functional limitations are related to lower family and friendship strain in husbands. Husbands' cognitive impairment also predicts higher family and friend support in wives. DISCUSSION Findings support a gendered dyadic relationship between health and social life and highlight women's caregiver role and better connection with family and friends. There are also differences between experiencing cognitive and physical limitations in couples. Finally, mild health impairment sometimes shows stronger effects on social relationships than severe impairment, suggesting adaptation to health transition.
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Affiliation(s)
- Jaclyn S Wong
- NORC, Department of Sociology, University of Chicago, Illinois
| | - Ning Hsieh
- Department of Sociology, Michigan State University, East Lansing
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Braunstein LZ, Taghian AG, Niemierko A, Salama L, Capuco A, Wong JS, Punglia RS, Bellon JR, MacDonald SM, Harris JR. Abstract P4-12-04: Breast cancer subtype, age and lymph node status as predictors of local recurrence following breast-conserving therapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-12-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose/Objectives: Advances in breast-conserving therapy (BCT) have yielded local control rates comparable or superior to those of mastectomy. Here, we sought to identify risk factors associated with isolated local recurrence (LR) following BCT.
Materials/Methods: This study included a multi-institutional cohort of 2,233 consecutive breast cancer patients who underwent BCT between 1998 and 2007. Patient characteristics and disease parameters were stratified by age, subtype and nodal status. Biologic subtype was approximated by receptor status and tumor grade. No patients received HER2/neu-directed therapy. The association of clinicopathologic features with LR was evaluated using Cox proportional hazards regression models.
Results: At a median follow-up of 106 months, 69 LR events (3.1%) were observed. Among the overall cohort, 10-year freedom from LR was 95.9%. On univariate Cox regression analysis, risk factors associated with LR included subtype other than luminal A (hazard ratio [HR] for luminal B = 3.01, HER2 = 6.29, triple negative [TNBC] = 4.72; p<0.001 for each), younger age (HR of oldest versus youngest quartile = 0.43; p=0.005), regional lymph node involvement (HR for 4-9 involved nodes = 3.04; >9 nodes = 5.82; p<0.01 for each), positive resection margins (HR = 2.43; p=0.005), and high-grade disease (HR = 5.37; p <0.001). Presence of LVI (HR = 1.56; p=0.06) or 1-3 involved nodes (HR = 1.55; p=0.07) approached significance. Multivariate Cox regression demonstrated an association with LR among those with non-luminal A subtypes (HR for luminal B = 2.64, HER2 = 5.42, TNBC = 4.32; p<0.001 for each), younger age (HR for age >50 = 0.56; p=0.01), and any nodal disease (HR=1.06 per involved node; p<0.004).
Conclusions: BCT yields favorable outcomes for the large majority of patients, although increased LR was observed among those with non-luminal A subtypes, younger age, and increasing lymph node involvement. Risk factors for LR following BCT appear to be converging with those following mastectomy in the current era.
Citation Format: Braunstein LZ, Taghian AG, Niemierko A, Salama L, Capuco A, Wong JS, Punglia RS, Bellon JR, MacDonald SM, Harris JR. Breast cancer subtype, age and lymph node status as predictors of local recurrence following breast-conserving therapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-12-04.
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Affiliation(s)
- LZ Braunstein
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - AG Taghian
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - A Niemierko
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - L Salama
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - A Capuco
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - JS Wong
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - RS Punglia
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - JR Bellon
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - SM MacDonald
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
| | - JR Harris
- Harvard Radiation Oncology Program; Dana Farber Cancer Institute; Massachusetts General Hospital
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Warren LE, Chen YH, Halasz LM, Capuco A, Bellon JR, Brock JE, Punglia RS, Wong JS, Harris JR. Abstract P3-17-07: Improved long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-17-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Improved mammographic and surgical techniques and pathologic evaluation, particularly greater attention to achieving negative margins, have resulted in decreased local recurrence rates for patients with ductal carcinoma in situ (DCIS). This is an updated analysis of local outcomes after breast-conserving surgery (BCS) and adjuvant radiation therapy (RT) at a single institution in the modern era.
Methods and Materials: We retrospectively reviewed the records of 245 women treated for DCIS with BCS and RT between 2001 and 2007. Competing risk analysis was used to calculate local recurrence (LR) as a first event with the development of a second non-breast malignancy, contralateral breast cancer, and death as competing first events. The median age at diagnosis was 54 (range, 32-84) and 174 (93%) women had estrogen receptor (ER) and/or progesterone receptor (PR) positive disease. Ninety-five (39%) were grade III. Specimen radiograph during surgery was obtained for 223 women (91%) and post-operative mammogram for 102 (42%). Half underwent more than one excision. The institutional goal for margins during the study period was 3 mm or greater; final margins were >2 mm in 221 (90%). All received adjuvant radiation therapy to the whole breast (median whole breast dose: 4400; range, 4000 - 5220) and nearly all (99%) received a boost to the surgical cavity (median boost dose: 1600; range, 800 – 1800). Among patients with ER and/or PR+ disease, 105 (60%) received adjuvant hormonal therapy.
Results: At a median follow-up of 10.6 years, 4 patients had a LR (2 DCIS, 2 invasive ductal carcinoma) as a first event with a cumulative LR incidence of 0.0% and 1.5% at 5 and 10 years, respectively. The 5 and 10-year cumulative incidence of the competing first events is seen in the table below. Twenty women developed a contralateral breast cancer (CBC; 8 DCIS, 12 invasive carcinoma), 13 were diagnosed with a second non-breast malignancy (3 endometrial, 2 fallopian tube, 1 gallbladder, 1 leukemia and thyroid, 4 lung, 1 ovarian, and 1 uterine), and 7 died. Family history, age at diagnosis, and receipt of hormonal therapy were not significantly associated with the development of CBC on univariable analysis (all p>0.05).
Incidence of local recurrence and competing eventsEvent5-year cumulative incidence10-year cumulative incidenceLocal recurrence0.0%1.5%Contralateral Breast Cancer2.5%7.9%Second non-breast malignancy2.6%4.5%Death1.2%3.5%
Conclusions: With longer follow-up, our rates of local recurrence following breast-conserving therapy for DCIS remain very low (1.5% at 10 years). The vast majority of patients had >2 mm margins, specimen radiographs, and received a tumor bed boost. The majority (60%) of patients with hormone receptor positive disease received adjuvant endocrine therapy. The 10-year incidence of CBC was higher than expected. Predisposing factors for the development of CBC are worthy of investigation.
Citation Format: Warren LE, Chen Y-H, Halasz LM, Capuco A, Bellon JR, Brock JE, Punglia RS, Wong JS, Harris JR. Improved long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-07.
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Affiliation(s)
- LE Warren
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - Y-H Chen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - LM Halasz
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - A Capuco
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - JR Bellon
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - JE Brock
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - RS Punglia
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - JS Wong
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
| | - JR Harris
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Washington, Seattle, WA; Brigham and Women's Hospital, Boston, MA
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Abstract
Stress process theory predicts that elder mistreatment leads to declines in health, and that social support buffers its ill effects. We test this theory using nationally representative, longitudinal data from 2,261 older adults in the National Social Life Health and Aging Project. We regress psychological and physical health in 2010/2011 on verbal and financial mistreatment experience in 2005/2006 and find that the mistreated have more anxiety symptoms, greater feelings of loneliness, and worse physical and functional health 5 years later than those who did not report mistreatment. In particular, we show a novel association between financial mistreatment and functional health. Contrary to the stress buffering hypothesis, we find little evidence that social support moderates the relationship between mistreatment and health. Our findings point to the lasting impact of mistreatment on health but show little evidence of a buffering role of social support in this process.
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Affiliation(s)
- Jaclyn S Wong
- a Department of Sociology , University of Chicago , Chicago , Illinois , USA.,b NORC at the University of Chicago , Chicago , Illinois , USA
| | - Linda J Waite
- a Department of Sociology , University of Chicago , Chicago , Illinois , USA.,b NORC at the University of Chicago , Chicago , Illinois , USA
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Abstract
Achieving treatment targets has been difficult in treating diabetic patients. This cross-sectional study describes the lipid profiles of patients with diabetes mellitus at a public primary health care centre in Sarawak, Malaysia. The targets for lipid control were based on the International Diabetes Federation recommendation (2002). 1031 patients (98% Type 2 Diabetes) were studied. Fasting lipid profiles were available in 990 (96%) patients. The mean total cholesterol was 5.3 ± 1.0 mmol/L, Triglycerides 1.90 ± 1.26 mmol/L, HDL-C 1.28 ± 0.33 mmol/ L and LDL-C 3.2 ± 0.9 mmol/L. Overall, 22% of patients achieved the treatment target for LDL-C level <2.6mmol/L. 67% of patients had HDL-C > 1.1 mmol/L and 42% of patients had a target TG level below 1.5 mmol/L. Of the 40% of patients who received lipid-lowering drug, 17% achieved LDL-C target, 50% had LDL-C 2.6-4.4mmol/ L and 33% have LDL-C > 4.0 mmol/L. For the remaining 60% not receiving any lipid lowering therapy, 68% had LDL-C between 2.6-4.0 mmol/L and 7% had LDL-C level > 4 mmol/L. Dyslipidemia is still under-treated despite the availability of effective pharmacological agents and the greatly increased risk of cardiovascular diseases in diabetic patients. Asia Pac J Public Health 2007; 19(3): 16-21.
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Affiliation(s)
- JS Wong
- Department of Medicine, Sarawak General Hospital, Kuching,
Sarawak, Malaysia,
| | - F. Tan
- Department of Medicine, Sarawak General Hospital, Kuching,
Sarawak, Malaysia
| | - PY Lee
- Department of Medicine, Faculty of Medicine and Health
Sciences, University Malaysia Sarawak, Sarawak, Malaysia
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D'cruz T, Wong JS. Case study of pancreas-preserving enucleation in the treatment of isolated pancreatic metastases of renal cell carcinoma. BMC Proc 2015. [PMCID: PMC4625203 DOI: 10.1186/1753-6561-9-s7-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chung AYF, Ooi LLPJ, Machin D, Tan SB, Goh BKP, Wong JS, Chen YM, Li PCN, Gandhi M, Thng CH, Yu SWK, Tan BS, Lo RHG, Htoo AMM, Tay KH, Sundram FX, Goh ASW, Chew SP, Liau KH, Chow PKH, Tay KH, Tan YM, Cheow PC, Ho CK, Soo KC. Adjuvant hepatic intra-arterial iodine-131-lipiodol following curative resection of hepatocellular carcinoma: a prospective randomized trial. World J Surg 2014; 37:1356-61. [PMID: 23463394 DOI: 10.1007/s00268-013-1970-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). METHODS From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan-Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong. RESULTS The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46-1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51-1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by (131)I-lipiodol and hepatic artery dissection during angiography. CONCLUSIONS The randomized trial provides insufficient evidence to recommend the routine use of (131)I-lipiodol in these patients.
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Affiliation(s)
- A Y F Chung
- General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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16
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Wong JS, B R, A F, I R, Fong AYY. Prevalence of asymptomatic atrial fibrillation in malaysian patients with hypertension. Med J Malaysia 2013; 68:141-143. [PMID: 23629560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial fibrillation (AF) is usually asymptomatic and often associated with established cardiovascular risk factors such as hypertension. The prevalence atrial fibrillation in patients admitted to Malaysian hospitals has been determined, but asymptomatic atrial fibrillation (AAF) in hypertensive patients in the primary care setting is not established. This study reports the prevalence of AAF in hypertensive patients in Malaysia, in a primary care setting. The overall prevalence of AAF was 0.75% with no differences between the gender. The prevalence of AAF increases with age - in the age groups of 30-39, >40-49, >50-59, >60-69, 70-79 and >80 years old were 0%, 0.17%, 0.35%, 2.32%, 2.59%, and 0% respectively. Hypertensive patients with age of ≥ 61 year old were associated with a probability of 10.6 times higher for AAF. We suggest the age threshold to screen for AAF to be age of 60. It is estimated that there are 49,029 Malaysians with AAF in 2010. A large population is at risk of AAF-related complications. There is justification for an even greater emphasis on diagnostic, primary and secondary prevention strategies.
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Affiliation(s)
- J S Wong
- Bintulu Hospital, Department of Medicine, Jalan Nyabau, Bintulu, Sarawak 97000, Malaysia.
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17
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Lee KF, Cheung YS, Wong J, Chong CC, Wong JS, Lai PB. Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre. Br J Surg 2012; 99:1203-9. [PMID: 22828986 DOI: 10.1002/bjs.8863] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The intermittent Pringle manoeuvre (IPM) is commonly applied during liver resection. Few randomized trials have addressed its effectiveness in reducing blood loss and the results have been conflicting. The present study investigated the hypothesis that IPM could reduce blood loss during liver resection by 50 per cent. METHODS Between May 2008 and April 2011, patients who underwent elective open hepatectomy were randomized into an IPM or no Pringle manoeuvre (NPM) group and stratified according to the presence or absence of cirrhosis. Data on demographics, type of hepatectomy, operative blood loss, duration of operation, mortality, morbidity and postoperative liver function were recorded and analysed. The primary endpoint was operative blood loss. RESULTS There were 63 patients in each group. Median (range) operative blood loss was 370 (50-3600) ml in the IPM group versus 335 (40-3160) ml in the NPM group (P = 1·000). There were no differences in blood loss in different phases of the operation, blood loss per area of liver transected or blood transfusion rate, nor in total duration of operation or liver transection time. Postoperative serum alanine aminotransferase levels were higher in the IPM group (P < 0·001). There were more postoperative complications in the IPM group (41 versus 24 per cent; P = 0·036). CONCLUSION The IPM did not reduce blood loss, but was associated with raised levels of postoperative liver parenchymal enzymes and more complications. REGISTRATION NUMBER NCT00730743 (http://www.clinicaltrials.gov).
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Affiliation(s)
- K F Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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18
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Teh CL, Wong JS, Soo HH. Polymyositis and dermatomyositis in Sarawak: a profile of patients treated in the Sarawak General Hospital. Rheumatol Int 2011; 32:265-8. [PMID: 21243497 DOI: 10.1007/s00296-010-1745-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 12/30/2010] [Indexed: 01/12/2023]
Abstract
We performed a cross-sectional study of the demography, clinical and laboratory features of patients with polymyositis and dermatomyositis followed up in our centre from 2006 to 2009. There were 12 cases, with the majority of them (58.3%) being woman. They have a mean age of 57.8 years and mean disease duration of 11.83 (SD 9.92) months. Our patients comprised of multi-ethnic groups with predominantly Chinese (83.3%), Sarawak natives (8.3%) and Malays (8.3%). They have a mean lag time to diagnosis of 3.67 (SD 4.27) months. Nine (75%) patients had dermatomyositis and 3(25%) had polymyositis. The common clinical manifestations found in our patients were proximal myopathy (100%), neck weakness (33.3%), dysphagia (33.3%) and interstitial lung disease (33.3%). For the nine patients with dermatomyositis, the most common dermatological manifestations were shawl sign (88.9%) and V sign (88.9%). Muscle enzymes were raised in 91.7% of patients. Electromyographies were carried out in four patients, and only one of our patients had muscle biopsy. Only 41.7% of our patients have positive ANA. The majority received prednisolone (100%) and hydroxychloroquine (58.3%). Malignancy occurred in five (three nasopharyngeal carcinomas, one sigmoid colon cancer and one lung cancer) out of the nine dermatomyositis patients but none in the polymyositis group. The mortality rate in our group was 4(33.3%) over the 4-year period. This study demonstrated the rarity of PM/DM in our centre with considerable lag time to diagnosis in our patients. Despite lack of muscle biopsy in our centre, our centre achieved appropriate diagnosis and management of PM/DM.
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Affiliation(s)
- C L Teh
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Jalan Hospital, 93450 Kuching, Sarawak, East Malaysia.
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19
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Wong JS, Smith BL, Troyan SL, Gadd MA, Gelman R, Lester SC, Schnitt SJ, Sgroi DC, Chen YH, Silver BJ, Harris JR. Abstract P1-15-03: Eight-Year Update of a Prospective Study of Wide Excision Alone for Ductal Carcinoma In Situ (DCIS) of the Breast. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-15-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The need for radiation therapy (RT) in conservatively managed DCIS is a source of ongoing debate. This is an updated analysis of a phase II prospective study of wide excision alone for DCIS. The study was activated in May 1995 and closed in July 2002 following accrual of 158 patients because the number of local recurrences (LR) met the predetermined stopping rules. The objective of the analysis is to update the distribution and cumulative incidence of events (LR, contralateral breast cancer [CBC], second malignancy and death from other causes). Materials and Methods: A total of 158 patients had DCIS with predominant nuclear grade 1 or 2, a mammographic extent of ≥2.5 cm, and excision with final microscopic margins of ≥1 cm or a re-excision without residual DCIS. Tamoxifen was not permitted. The results presented are from the 8-year analysis (8-year minimum potential follow-up time). Twenty-six patients without recurrence who were followed less than 8 years were excluded from the analysis as were 7 first events (4 LR) that occurred beyond 8 years of follow-up; the analysis thus includes 132 patients and 36 first events. Cumulative incidence curves were generated to assess the rates of LR or other events. Median follow up time was 10 years. Results: Overall, 36/132 patients (27%) had a first event as of April 2010. Of these 36 events, 19 were LR, 13 were CBC, 1 was a second malignancy, and 3 were deaths from other causes. Of the 19 LR, 13 (68%) were DCIS only and 6 (32%) were invasive. Fourteen occurred in the same quadrant and 5 were elsewhere in the ipsilateral breast. The 8-year estimated cumulative incidence of LR was 14.4% (95% CI: 8.4-20.4%). For all other events, the 8-year estimated cumulative incidence was 12.9% (95% CI: 3.6-13.1%).
The estimated annual percentage rates of LR, CBC, and other events were 2.1%, 1.5% and 0.4%, respectively.
Discussion: The results of this prospective study demonstrate a substantial and ongoing risk of LR and CBC in patients with small, nuclear grade 1 or 2 DCIS treated with wide excision with margins of ≥1cm in the absence of RT. Most LRs occurred in the same quadrant, rather than elsewhere in the breast, suggesting that excision alone is inadequate even for this highly selected population. Further study is warranted to determine if there is a subgroup of DCIS patients with nuclear grade 1 or 2 disease who are at low enough risk of LR following wide excision that RT can be omitted safely.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-15-03.
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Affiliation(s)
- JS Wong
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - BL Smith
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - SL Troyan
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - MA Gadd
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - R Gelman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - SC Lester
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - SJ Schnitt
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - DC Sgroi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - Y-H Chen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - BJ Silver
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - JR. Harris
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA
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20
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Teh CL, Wong JS, Ngeh NKN, Loh WLH. Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia. Rheumatol Int 2010; 31:1153-7. [PMID: 20349069 DOI: 10.1007/s00296-010-1435-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
Abstract
We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.
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Affiliation(s)
- C L Teh
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Jalan Hospital, 93450, Kuching, Sarawak, East Malaysia.
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21
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Ching BC, Wong JS, Tan MH, Jara-Lazaro AR. The many faces of intraosseous haemangioma: a diagnostic headache. Singapore Med J 2009; 50:e195-e198. [PMID: 19495509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Intraosseous haemangioma constitutes less than ten percent of all primary bone neoplasms. Approximately 75 percent occur in the calvarium or vertebrae, with long bones, short tubular bones and ribs constituting the rest. We describe a 52-year-old woman who presented with left knee pain for 4-5 years and loss of weight over one week. An initial radiograph of the knee showed several well circumscribed isodense lesions with sclerotic rims in the medullary cavity of the distal femur and diaphysis of the left tibia. There were also lucent lesions with a slightly sclerotic rim in the diaphysis of the left tibia and proximal left fibula. In view of the clinical presentation and radiological findings, extensive investigations were made to rule out metastases and multiple myeloma. An open biopsy with segmental osteotomy of the left mid fibular lesion revealed an intraosseous haemangioma.
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Affiliation(s)
- B C Ching
- Department of Oncologic Imaging, 11 Hospital Drive, National Cancer Centre, Singapore.
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22
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Abstract
We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a two-year period (2006–2007) to describe the clinical features, maternal and foetal outcomes in our centre. There were 17 pregnancies in 16 women with SLE. Our patients have a mean age of 28.31 years (SD 5.24) and a mean disease duration of 38.62 months (SD 38.03). Our patients have complicated pregnancies: 35.3% have SLE flares, 21.1% have preeclampsia and 47.4% needed caesarean sections. There were 15.8% foetal losses and 12.5% preterm deliveries in our patients. All the foetal losses occurred in patients with severe SLE flares during pregnancies. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable with developed countries. The low incidence of antiphospholipid syndrome, the high usage of hydroxychloroquine and the high SLE remission rate in our patients before conceptions are the possible factors contributing to the good outcome.
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Affiliation(s)
- CL Teh
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - JS Wong
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - NKN Ngeh
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Sarawak, Malaysia
| | - WLH Loh
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Sarawak, Malaysia
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23
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Teh CL, Wong JS. The pattern and clinical manifestations of rheumatoid arthritis in Sarawak General Hospital. Clin Rheumatol 2008; 27:1437-40. [PMID: 18773254 DOI: 10.1007/s10067-008-0945-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/22/2008] [Accepted: 05/27/2008] [Indexed: 12/28/2022]
Abstract
The aim of our study is to describe the pattern, clinical features, treatment regimes, and disease activity among the patients treated for rheumatoid arthritis (RA) in the Sarawak General Hospital. We performed a cross-sectional study of all patients with a diagnosis of RA who received treatment at the General Medical Clinic and the Rheumatology Clinic in Sarawak General Hospital over a 1-year period from 1st June 2006 to 31st May 2007. Demographic data, clinical features, and disease activity of all 154 patients were collected for statistical analysis. Rheumatoid arthritis afflicts all the major racial groups in Sarawak including the native population. Our patients have a mean disease duration of 5.4 years (SD 5.69) and a mean duration of delay in diagnosis RA and initiation of disease-modifying antirheumatic drug (DMARD) treatment of 42.9 months (SD 60.1). They have a low rate of interstitial lung disease (6.5%) and rheumatoid nodules (4.5%). Rheumatoid factor was positive in 65.5% of our patients. They have a mean Disease Activity Score (DAS) 28 score of 4.28 (SD 1.33). Only 12.5% of our patients are in remission with DAS 28 < 2.6 and 30.9% of our patients are having high disease activity with DAS 28 > 5.1. Despite the high usage of DMARDs in Sarawak (>80%), our patients have severe disease with high disease activity indices. This is most likely due to delay in diagnosis and initiating DMARDs in RA patients in Sarawak.
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Affiliation(s)
- C L Teh
- Department of Medicine, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia.
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Tan F, Chan G, Wong JS, Rozario F. Standard of care for type 2 diabetic patients in a public hospital general medical clinic: report of a self-audit. Med J Malaysia 2008; 63:224-228. [PMID: 19248695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We audited the standard of care provided to 200 consecutive type 2 diabetic patients attending our hospital general medical clinic. Data on diabetes related processes and outcome measures were collected. Annual testing rates (blood pressure 100%, fasting lipid profile 91.8%, HbA1c 69%) were higher compared to complications screening rates (Eye 69%, albuminuria 51%, foot 22.4%). Lifestyle intervention was lacking with BMI documented in 38.3% of patients and smoking history in 46%. Fifty percent and 41% of patients with HbA1c > 7.5% were referred to diabetes educator and dietitian respectively. For outcome measures, 26% of patients achieved HbA1c < or = 7%, 33% achieved BP < or = 130/80 while 56% achieved LDL < or = 2.6 mmol/L. Aspirin was prescribed in 78% and ACE inhibitor or angiotensin receptor blocker in 91.8% of patients. Lifestyle intervention and complication screening are the two major areas of deficiencies in the care of type 2 diabetic patients in our hospital general medical clinic.
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Affiliation(s)
- F Tan
- Department of Medicine, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, 93586 Kuching, Sarawak, Malaysia.
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25
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Lee KC, Goh WLP, Xu M, Kua N, Lunny D, Wong JS, Coomber D, Vojtesek B, Lane EB, Lane DP. Detection of the p53 response in zebrafish embryos using new monoclonal antibodies. Oncogene 2007; 27:629-40. [PMID: 17684488 DOI: 10.1038/sj.onc.1210695] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The zebrafish has many advantages as a vertebrate model organism and has been extensively used in the studies of development. Its potential as a model in which to study tumour suppressor and oncogene function is now being realized. Whilst in situ hybridization of mRNA has been well developed in this species to study gene expression, antibody probes are in short supply. We have, therefore, generated a panel of anti-zebrafish p53 monoclonal antibodies and used these to study the p53 response in zebrafish embryos. By immunohistochemistry, we show that the exposure of zebrafish embryos to p53-activating agents such as R-roscovitine and gamma-irradiation results in the accumulation of p53 protein in the gut epithelium, liver and pancreas. A combination of R-roscovitine and gamma-irradiation results in massive p53 induction, not only in the pharyngeal arches, gut region and liver but also in brain tissues. Induction of apoptosis and expression of p53 response genes are seen in regions that correspond to sites of p53 protein accumulation. In contrast, although zebrafish tp53(M214K) mutant embryos showed a similar accumulation of p53 protein, a complete lack of a downstream p53-dependent response was observed. In this system the p53 gene is identified as a p53-responsive gene itself. Our results demonstrate that zebrafish p53 protein can readily be induced in embryos and detected using these new antibody tools, which will increase the usefulness of zebrafish as a model in compound-based screening for novel drugs in cancer research.
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Affiliation(s)
- K-C Lee
- Control of p53 Pathway Laboratory, Institute of Molecular and Cell Biology, Proteos, Singapore
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Abstract
This is a prospective study conducted from February 2000 to July 2002 in a single neurosurgeon neurosurgical service in the state of Sarawak, Malaysia. There were 66 cases of subarachnoid hemorrhage or intracranial aneurysm presenting to this hospital over the study period. Fifty cases had their aneurysms clipped. Eighty percent of our patients were operated within 48 h of presentation. Forty-four percent presented with poor WFNS grades of 4 and 5. We had a 20% operative mortality and 29% total management mortality. Twenty-nine (58%) of the operated cases had a favorable outcome with a mean follow-up of 32 weeks. Multiple aneurysms were less common. The diagnosis of aneuysmal subarachnoid hemorrhage and clipping of aneurysms have increased dramatically over the previous two and half years indicating an increased awareness of the diagnosis and treatment. This series supports the previously reported beliefs that the lower rate of aneurymal subarachnoid hemorrhage in developing countries is likely due to both underdiagnosis and undertreatment. Good results can be achieved in developing countries with early diagnosis and intensive management.
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Affiliation(s)
- J S Wong
- Hospital Umum Sarawak, Jalan Tun Ahmad Zaidi Adruce, Kuching, Sarawak, Malaysia
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27
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Nor Zainura Z, Barkeh HJ, Wong JS, Muhaya M. A rare case of subretinal cysticercosis. Med J Malaysia 2005; 60:650-2. [PMID: 16515120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This is a case of a 25 year old lady whose eye had been infected by cysticercosis. This case highlighted that the inflammation was due to host immune response. She was treated with oral corticosteroid and the lesions regressed.
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Affiliation(s)
- Z Nor Zainura
- Department of Surgery, Faculty of Medicine & Health Science, Universiti Putra Malaysia, Serdang, Selangor, Kuala Lumpur
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Wong JS. Proteinuria in diabetic patients in a primary health care setting in Sarawak. Med J Malaysia 2005; 60:146-50. [PMID: 16114154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Diabetic nephropathy is now the number one cause of end stage renal failure in Malaysia. This places a huge burden on patients and the health care system especially in developing countries with limited health care resources, such as in Sarawak in East Malaysia. This study describes the prevalence of proteinuria/microalbuminuria in diabetic patients treated in Klinik Kesihatan Tanah Puteh. Early detection of proteinuria/microalbuminuria allows remedial measures to be taken to retard the progression of nephropathy. Forty-eight percent of the cases had proteinuria and microalbuminuria was found in 16%. Seventy-eight percent of cases with proteinuria were on treatment with angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers. Seventy-five percent of patients had hypertension but only 6% achieved the targeted BP of < 130/80 mmHg.
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Affiliation(s)
- J S Wong
- Department of Medicine, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, 93586 Kuching, Sarawak
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Wong JS, Rahimah N. Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: the Tanah Puteh Health Centre experience. Med J Malaysia 2004; 59:411-7. [PMID: 15727390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c <6.5%), fair in 34% (HbA1c 6.5-7.5%) and poor in 38% (HbA1c >7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak.
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Affiliation(s)
- J S Wong
- Department of Medicine, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, 93586 Kuching, Sarawak, Malaysia
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30
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Abstract
PURPOSE To highlight the systemic factors which affect onset and/or progression of diabetic retinopathy (DR) and to emphasize the role and responsibilities of ophthalmologists and other eye care providers to ensure that appropriate systemic medical evaluation of the patient with diabetes is being pursued. DESIGN Literature review of publications relevant to diabetic retinopathy, blood glucose control, diabetes mellitus type, hypertension, renal disease, elevated serum lipids, exercise, pregnancy, anticoagulation, thrombolysis, smoking, anemia and antioxidant ingestion. FINDINGS Intensive blood glucose control and control of systemic hypertension reduce the risk of new onset DR and slow the progression of existing DR. Severe DR may be an indicator of renal disease while severe renal disease and its treatment can affect the progression of DR. Elevated serum lipids are associated with macular exudate and moderate visual loss. Certain types of excessive exercise in patients with advanced stages of retinopathy may aggravate vitreous hemorrhage. During pregnancy, DR should be monitored closely as transient progression of DR can occur. Therapeutic anticoagulation and thrombolysis are not contraindicated at any stage of DR. Anemia can result in progression of DR, smoking in general should be discouraged, and the role of antioxidant therapy requires further study. CONCLUSIONS Blindness from diabetic retinopathy is now largely preventable with timely detection and appropriate interventional therapy. Routine, repetitive, lifelong, expert clinical retinal examination is essential for the fundamental ophthalmic care of the patient with diabetes. However, diabetes mellitus is a systemic disease and thus optimal ophthalmic care must include diligent evaluation and treatment of concomitant systemic disorders that influence the development, progression and ultimate outcome of diabetic retinopathy. Optimization of these systemic considerations through an intensive, multi-disciplinary, healthcare team-based approach will maximize the ophthalmic and general health of these patients. Ophthalmologists and other eye care providers are critical members of this team with unique responsibilities to ensure that appropriate systemic medical evaluation is being pursued.
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Affiliation(s)
- L P Aiello
- Beetham Eye Institute, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA.
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Nanjee MN, Cooke CJ, Wong JS, Hamilton RL, Olszewski WL, Miller NE. Composition and ultrastructure of size subclasses of normal human peripheral lymph lipoproteins: quantification of cholesterol uptake by HDL in tissue fluids. J Lipid Res 2001; 42:639-48. [PMID: 11290836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Peripheral lymph lipoproteins have been characterized in animals, but there is little information about their composition, and none about their ultrastructure, in normal humans. Therefore, we collected afferent leg lymph from 16 healthy males and quantified lipids and apolipoproteins in fractions separated by high performance-size exclusion chromatography. Apolipoprotein B (apoB) was found almost exclusively in low density lipoproteins. The distribution of apoA-I, particularly in lipoprotein A-I (LpA-I) without A-II particles, was shifted toward larger particles relative to plasma. The fractions containing these particles were also enriched in apoA-II, apoE, total cholesterol, and phospholipids and had greater unesterified cholesterol-to-cholesteryl ester ratios than their counterparts in plasma. Fractions containing smaller apoA-I particles were enriched in phospholipid. Most apoA-IV was lipid poor or lipid free. Most apoC-III coeluted with large apoA-I-containing particles. Electron microscopy showed that lymph contained discoidal particles not seen in plasma. These findings support other evidence that high density lipoproteins (HDL) undergo extensive remodeling in human tissue fluid. Total cholesterol concentration in lymph HDL was 30% greater (P < 0.05) than could be explained by the transendothelial transfer of HDL from plasma, providing direct confirmation that HDL acquire cholesterol in the extravascular compartment. Net transport rates of new HDL cholesterol in the cannulated vessels corresponded to a mean whole body reverse cholesterol transport rate via lymph of 0.89 mmol (344 mg)/day.
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Affiliation(s)
- M N Nanjee
- Department of Cardiovascular Biochemistry, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK
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Duncan SM, Hyndman K, Estabrooks CA, Hesketh K, Humphrey CK, Wong JS, Acorn S, Giovannetti P. Nurses' experience of violence in Alberta and British Columbia hospitals. Can J Nurs Res 2001; 32:57-78. [PMID: 11928302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
This study examined responses to a survey on violence in the workplace from a sample of 8,780 registered nurses practising in 210 hospitals in the Canadian provinces of Alberta and British Columbia. Findings relate to the frequency of violence against nurses, reported as the number of times they experienced a violent incident in the workplace. Nearly half (46%) of those surveyed had experienced 1 or more types of violence in the last 5 shifts worked. Frequency varied by type: emotional abuse 38%, threat of assault 19%, physical assault 18%, verbal sexual harassment 7.6%, sexual assault 0.6%. Further, 70% of those who had experienced violence indicated they had not reported it. Patients constituted the main source of all types of violence. The most prevalent type, emotional abuse, was further explored for its possible determinants. This was also the type of violence most evenly distributed among sources (patients, families, co-workers, physicians). Multiple regression modelling using the individual nurse as the unit of analysis showed the significant predictors of emotional abuse to be age, casual job status, quality of care, degree of hospital restructuring, type of unit, relationships among hospital staff, nurse-to-patient ratios, and violence-prevention measures; using the hospital as the unit of analysis the predictors were found to be quality of care, age, relationships with hospital staff, presence of violence-prevention measures, and province. These findings illustrate important differences in models that use the individual and the institution as the unit of analysis. Implications include targeting prevention strategies not only at the nurse but, perhaps more importantly, at the hospital. Overall, the findings suggest that health-care institutions are not always healthy workplaces and may increasingly be stressful and hazardous ones.
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Affiliation(s)
- S M Duncan
- School of Nursing, University College of the Cariboo, Kamloops, British Columbia, Canada
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Chan CM, Chew PT, Alsagoff Z, Wong JS, Tan DT. Vascular patterns in pterygium and conjunctival autografting: a pilot study using indocyanine green anterior segment angiography. Br J Ophthalmol 2001; 85:350-3. [PMID: 11222345 PMCID: PMC1723902 DOI: 10.1136/bjo.85.3.350] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To characterise the vasculature of pterygium using indocyanine green (ICG) anterior segment angiography and to demonstrate the pattern of revascularisation following conjunctival autografting. METHODS ICG anterior segment angiography was performed on nine patients with pterygium. Angiography was repeated at 1-2 weeks and 2 months following conjunctival autografting in these patients. RESULTS Angiography showed a single feeder vessel originating from the anterior conjunctival circulation in six cases (66.7%). This vessel branched to form the radial vessels of the pterygium. Following conjunctival autografting, reperfusion of the vessels in the conjunctival autograft was demonstrable as early as 1 week postoperatively from the episcleral bed. At 2 months postoperatively, the graft appeared well perfused with mild leakage demonstrable at the edges of the graft. CONCLUSIONS A single feeder vessel from the anterior conjunctival circulation branches to form the radial vessels in pterygium. Reperfusion of conjunctival autografts occurs as early as 1 week postoperatively from the episcleral bed.
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Alsagoff Z, Chew PT, Chee CK, Wong JS, Aung T. Indocyanine green anterior segment angiography for studying conjunctival vascular changes after trabeculectomy. Clin Exp Ophthalmol 2001; 29:22-6. [PMID: 11272780 DOI: 10.1046/j.1442-9071.2001.00365.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the use of indocyanine green (ICG) for angiography of the anterior segment to characterize conjunctival and episcleral vasculature changes after trabeculectomy. METHODS This was a prospective evaluation of anterior segment ICG angiography in 10 eyes of 10 patients undergoing trabeculectomy for the first time. Trabeculectomy was performed with intraoperative sponge application of 5-fluorouracil (5 cases) or mitomycin C (5 cases). Anterior segment ICG angiography was performed prior to surgery, then at 2 weeks and 2 months after surgery. RESULTS With ICG, the anterior segment vessels were well delineated, including deep episcleral veins, which have not been clearly shown in previous angiographic techniques. Late phases of the angiogram could also be studied. The vascular alterations after trabeculectomy noted included oss of vascularity over the bleb area and vascular anastomoses along the perimeter of the avascular bleb. CONCLUSIONS Angiography using ICG has potential as an investigative tool to study the conjunctival and episcleral vasculature changes after trabeculectomy.
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Affiliation(s)
- Z Alsagoff
- Singapore National Eye Centre, National University of Singapore
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Abstract
The overall importance of local tumour control in the management of breast cancer, specifically the influence of local control on survival, remains one of the fundamental questions for oncologists. This review addresses the issues surrounding local tumour control, including the evolution of the concept of disease spread, the rationale for local control, the results of studies of radiotherapy after breast-conserving surgery and after mastectomy, and an interpretation of the recent data on post-mastectomy radiotherapy.
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Affiliation(s)
- J S Wong
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA.
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Buhman KK, Accad M, Novak S, Choi RS, Wong JS, Hamilton RL, Turley S, Farese RV. Resistance to diet-induced hypercholesterolemia and gallstone formation in ACAT2-deficient mice. Nat Med 2000; 6:1341-7. [PMID: 11100118 DOI: 10.1038/82153] [Citation(s) in RCA: 264] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The importance of cholesterol ester synthesis by acyl CoA:cholesterol acyltransferase (ACAT) enzymes in intestinal and hepatic cholesterol metabolism has been unclear. We now demonstrate that ACAT2 is the major ACAT in mouse small intestine and liver, and suggest that ACAT2 deficiency has profound effects on cholesterol metabolism in mice fed a cholesterol-rich diet, including complete resistance to diet-induced hypercholesterolemia and cholesterol gallstone formation. The underlying mechanism involves the lack of cholesterol ester synthesis in the intestine and a resultant reduced capacity to absorb cholesterol. Our results indicate that ACAT2 has an important role in the response to dietary cholesterol, and suggest that ACAT2 inhibition may be a useful strategy for treating hypercholesterolemia or cholesterol gallstones.
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Affiliation(s)
- K K Buhman
- Gladstone Institute of Cardiovascular Disease, P.O. Box 419100, San Francisco, California 94141-9100, USA
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Wong JS, Aiello LP. Diabetic retinopathy. Ann Acad Med Singap 2000; 29:745-52. [PMID: 11269982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION To provide a review of the current standard of care in diabetic eye management. METHODS A non-systematic evidence-based review utilising available data and consensus statements on the subject matter. RESULTS Diabetes mellitus affects some 9.0% of Singaporeans, and more than 60% of patients with diabetes in this population remained undiagnosed. Diabetic retinopathy is an important complication among diabetic patients and adverse visual outcome associated with this condition can be reduced by more than 95% by taking measures including good glycaemic control, timely and appropriate laser therapy, and vitrectomy surgery when indicated. An important aspect of management is the accurate disease classification which is essential for prognostication, appropriate follow-up schedule, and timing of therapeutic intervention purposes. CONCLUSION Diabetic retinopathy will remain a significant problem if the current trend in diabetes among Singapore residents prevails. As the severe visual impairment associated with diabetic retinopathy can be largely prevented with appropriate and timely intervention, the major challenge to the health care providers today is the identification and education of patients with diabetes, and the enrollment of these patients in a life-long comprehensive ophthalmic management programme in order to minimise visual morbidity.
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Affiliation(s)
- J S Wong
- Beetham Eye Institute, Joslin Diabetes Center, Boston, USA.
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Abstract
PURPOSE To investigate the validity of clinical estimates of intraocular pressure (IOP) in Chinese people. DESIGN Prospective, cross-sectional, hospital-based in vivo study. PARTICIPANTS Twenty-three ethnic Chinese adults (aged 35-82 years) undergoing routine phacoemulsification surgery were examined. TESTING "True" IOP was measured with a solid-state hemodynamic monitor through a cannula in the anterior chamber. IOP was set successively to 10, 20, and 30 mmHg in each subject, using a reservoir of balanced salt solution. Intraocular pressure was simultaneously estimated by use of a hand-held applanation tonometer (Perkin's) and a Tono-Pen. The association between ocular biometric variables and measurement error was examined. MAIN OUTCOME MEASURES The median of three readings at each IOP level was taken as the IOP estimate of each instrument. Measurement error was calculated as the mean difference (tonometer minus direct measurement). RESULTS The error for the hand-held applanation tonometer was -1.6, -4.3 and -5.7 at 10, 20, and 30 mmHg, respectively. For the Tono-Pen the measurement error was +0.4, -2.0, and -4.1 at 10, 20, and 30 mmHg, respectively. We could identify no association between measurement error and corneal thickness or curvature, anterior chamber depth, or axial length. CONCLUSIONS The applanation tonometer and Tono-Pen underestimate the true IOP in Chinese eyes. Error increases as true IOP increases. These tonometers do not give an accurate estimate of IOP in East Asians.
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Affiliation(s)
- P J Foster
- Singapore National Eye Centre, Singapore. Institute of Ophthalmology, University College, London, England UK
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Estabrooks CA, Duncan SM, Hyndman K, Hesketh K, Humphrey CK, Wong JS, Reimer MA, Acorn S, Giovannetti P. Nurses' experience of violence. Can Nurse 2000; 96:6. [PMID: 11865507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
BACKGROUND Much of the morbidity and mortality associated with diabetes mellitus predominantly reflects its deleterious effects on microcirculation and macrocirculation. During the past few years, rapid advancement has been made in our understanding of the mechanisms and molecules involved in the pathogenesis of diabetic microvasculopathy. This is particularly true with regard to retinal vascular disease and the role of the angiogenesis- and vasopermeability-inducing molecule, vascular endothelial growth factor (VEGF). METHODS Biochemical studies in many relevant cell types have been performed. Effects of VEGF action and inhibition have been evaluated in animals. Interventions that block the biochemical pathways initiated by VEGF have been tested both in culture and in animals. Human clinical trials have begun. RESULTS VEGF induces vascular endothelial cell proliferation, migration and vasopermeability in many cells and tissues. In vivo, VEGF has been identified as a primary initiator of proliferative diabetic retinopathy, and as a potential mediator of nonproliferative retinopathy. In addition, VEGF has been implicated in the development of neuropathy and nephropathy in the patient with diabetes. In patients with diabetes and coronary artery or peripheral vascular disease, VEGF may induce development of cardiac and limb vascular collateralization, respectively. Many biochemical processes mediating these actions have now been elucidated. CONCLUSIONS VEGF appears to play a central role in mediating diabetic vasculopathy in many organs. Improved understanding of the molecular mechanisms underlying these processes has permitted development of novel therapeutic interventions, several of which are now in human clinical trials. These scientific advances and various implications for the future care of vasculopathy associated with diabetes will be discussed.
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Affiliation(s)
- L P Aiello
- Beetham Eye Institute and Division of Vascular Cell Biology, Joslin Diabetes Center, Boston, Massachusetts, 02215, USA.
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Yang JC, Siu TS, Ng KF, Gong Z, Tsui SL, Wong JS. Combined effect of isoflurane and esmolol on sympathetic responses to tracheal intubation. Acta Anaesthesiol Sin 2000; 38:123-30. [PMID: 11125686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Influences of isoflurane and esmolol on endotracheal intubation induced sympathetic changes could be different. The effect of isoflurane and its combination with esmolol on catecholamine, blood pressure and pulse during endotracheal intubation were investigated. METHODS Thirty patients were anesthetized with 3.0% isoflurane and tracheal intubation was carried out at the 5th min following the exposure to isoflurane. Half of them received intravenous saline and the other half received esmolol 2 mg/kg at the 4th min. Cardiovascular parameters were recorded and venous blood samples were taken for measurement of catecholamines every min. RESULTS One min after administration of isoflurane, there was increase of heart rate (P < 0.05), while at the same time the epinephrine level fell (P < 0.05) and norepinephrine level remained unaltered. Both catecholamines raised after intubation (P < 0.05). The sympathetic responses to and the beta-antagonistic effect of esmolol on intubation were not significantly changed in the presence of isoflurane. CONCLUSIONS Isoflurane increased heart rate while paradoxically decreased epinephrine. Norepinephrine was more specifically related to endotracheal intubation, for its serum level had little change before the event. Based on catecholamine findings, the mechanism of isoflurane effect on the sympathetic system is probably different from that of endotracheal intubation.
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Affiliation(s)
- J C Yang
- Department of Anesthesiology, University of Hong Kong
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Abstract
PURPOSE To report 32 eyes of 27 patients with endogenous bacterial endophthalmitis seen over a 4 year period. Features and outcomes of this condition in the current series and the cases reported in the literature from 1986-1998 were reviewed. DESIGN Retrospective noncomparative case series. PARTICIPANTS All patients with this condition seen at the three participating general hospitals were included. INTERVENTION A review of the systemic and ocular characteristics, therapeutic methods, and final outcomes in patients afflicted with this condition. MAIN OUTCOME MEASURES Features studied included patients' demographic characteristics, microbiology, source of infection, ocular features, therapeutic interventions, final visual and anatomic outcomes. RESULTS Nineteen (70%) of the 27 incriminating organisms in this case series were gram negative microbes, with Klebsiella pneumoniae infections alone being responsible in 16 (60%) cases. Hepatobiliary tract infection was the source of bacteremia in 13 (48%) patients. Only nine (28%) eyes obtained good final visual acuity (20/120 or better), and two eyes were enucleated/eviscerated. A literature review of 209 patients with endogenous endophthalmitis over a 12 year period showed a similar increase in the frequency of gram negative microbes as the responsible organism, especially among the East Asian population. Overall, 22% had bilateral involvement; two thirds of patients had predisposing factor(s) or underlying illness(es), and diabetes mellitus was present in 46%. Thirty-four percent of all eyes obtained counting finger or better final vision, and 16% had their eyes eviscerated or enucleated. Infections with virulent organisms (gram negative rods, Serratia, Bacillus) usually denoted a grave visual prognosis; however, a media that was not opaque on presentation was usually associated with a good prognosis. CONCLUSION Metastatic ocular infection is not uncommon despite the availability of modern antibiotic therapy. Among the East Asian population, the patient at highest risk is a diabetic patient with Klebsiella pneumoniae hepatobiliary infection. In contrast, in the Caucasian population, this condition occurs in predisposed patients with gram-positive bacteremia arising from endocarditis or skin/joint infections. The final visual outcome in patients with endogenous bacterial endophthalmitis in the recent 12 years has not differed significantly from five decades ago.
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Affiliation(s)
- J S Wong
- Singapore National Eye Center, Singapore. Department of Ophthalmology, National University Hospital, Singapore
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Wong JS, O'Neill A, Recht A, Schnitt SJ, Connolly JL, Silver B, Harris JR. The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection? Int J Radiat Oncol Biol Phys 2000; 48:133-7. [PMID: 10924982 DOI: 10.1016/s0360-3016(00)00605-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0-3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. METHODS AND MATERIALS In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. RESULTS LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0-3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0-7.6). CONCLUSION For patients with clinical T1-2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1-2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.
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Affiliation(s)
- J S Wong
- Joint Center for Radiation Therapy, Boston, MA, USA.
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Lim CC, Sitoh YY, Hui F, Lee KE, Ang BS, Lim E, Lim WE, Oh HM, Tambyah PA, Wong JS, Tan CB, Chee TS. Nipah viral encephalitis or Japanese encephalitis? MR findings in a new zoonotic disease. AJNR Am J Neuroradiol 2000; 21:455-61. [PMID: 10730635 PMCID: PMC8174990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND PURPOSE An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998-1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus. METHODS The brain MR images of eight patients with Nipah virus infection were reviewed. All patients tested negative for acute Japanese encephalitis virus. Seven patients had contrast-enhanced studies and six had diffusion-weighted examinations. RESULTS All patients had multiple small bilateral foci of T2 prolongation within the subcortical and deep white matter. The periventricular region and corpus callosum were also involved. In addition to white matter disease, five patients had cortical lesions, three had brain stem involvement, and a single thalamic lesion was detected in one patient. All lesions were less than 1 cm in maximum diameter. In five patients, diffusion-weighted images showed increased signal. Four patients had leptomeningeal enhancement and four had enhancement of parenchymal lesions. CONCLUSION The brain MR findings in patients infected with the newly discovered Nipah paramyxovirus are different from those of patients with Japanese encephalitis. In a zoonotic epidemic, this striking difference in the appearance and distribution of lesions is useful in differentiating these diseases. Diffusion-weighted imaging was advantageous in increasing lesion conspicuity.
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Affiliation(s)
- C C Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore
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Abstract
PURPOSE Diode laser (810 nm) may possess theoretical advantages over the argon blue-green laser (488 nm) for iridotomy/iridoplasty in an eye with oedematous cornea, such as the acute angle-closure glaucoma (AACG) patient, because of better diode laser tissue penetration in opaque media. We assessed the transmissibility of diode and argon lasers through corneas of varying clarity and evaluated the histopathological features of cornea and iris burns produced by these lasers. METHODS The transmission of diode and argon lasers through human donor corneal buttons of three grades of clarity--clear, intermediate, and hazy--were compared. Corneal buttons of these varying levels of clarity were also treated with argon and diode lasers, with the beams deliberately focused onto the mid-stroma to assess their photothermal effects. Exposed pigmented irides from whole human eyes were treated directly with argon and diode lasers. The lasers were delivered via slit-lamp systems and the energy settings used were 1000 mW for argon and 980 mW for diode; spot sizes for both lasers were 100 microm, with exposure durations of 0.1 s. Light microscopy studies of these tissues were performed. RESULTS Transmissibility of diode laser in clear, intermediate, and hazy corneas were 89, 87 and 85% respectively and was significantly superior to argon laser (78, 73 and 70% respectively; P < 0.001, paired Student's t-test). Diode laser did not produce morphological changes in all three grades of corneas whereas argon-laser-treated hazy corneas showed photothermal damage. Both lasers produced deep iris burns, with the diode laser tending to produce deeper burns. CONCLUSION Our findings suggest that diode laser may be the ideal laser for iridotomy/iridoplasty in the AACG patient with hazy cornea.
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Affiliation(s)
- P T Chew
- Department of Ophthalmology, National University of Singapore, Singapore.
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Abstract
Spontaneous suprachoroidal bleeding is a rare event. Of the six previously reported cases, five had identifiable mechanisms for the development of choroidal bleeding in addition to concurrent systemic anticoagulation/thrombolytic therapy. We report a case of spontaneous suprachoroidal haemorrhage in a patient who received subcutaneous low-molecular-weight heparin therapy but without any identifiable ocular condition predisposing to choroidal bleeding.
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Affiliation(s)
- J S Wong
- Department of Ophthalmology, National University Hospital, Singapore.
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Terasawa Y, Cases SJ, Wong JS, Jamil H, Jothi S, Traber MG, Packer L, Gordon DA, Hamilton RL, Farese RV. Apolipoprotein B-related gene expression and ultrastructural characteristics of lipoprotein secretion in mouse yolk sac during embryonic development. J Lipid Res 1999; 40:1967-77. [PMID: 10553000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
In mice, the yolk sac appears to play a crucial role in nourishing the developing embryo, especially during embryonic days (E) 7;-10. Lipoprotein synthesis and secretion may be essential for this function: embryos lacking apolipoprotein (apo) B or microsomal triglyceride transfer protein (MTP), both of which participate in the assembly of triglyceride-rich lipoproteins, are apparently defective in their ability to export lipoproteins from yolk sac endoderm cells and die during mid-gestation. We therefore analyzed the embryonic expression of apoB, MTP, and alpha-tocopherol transfer protein (alpha-TTP), which have been associated with the assembly and secretion of apoB-containing lipoproteins in the adult liver, at different developmental time points. MTP expression or activity was found in the yolk sac and fetal liver, and low levels of activity were detected in E18.5 placentas. alpha-TTP mRNA and protein were detectable in the fetal liver, but not in the yolk sac or placenta. Ultrastructural analysis of yolk sac visceral endoderm cells demonstrated nascent VLDL within the luminal spaces of the rough endoplasmic reticulum and Golgi apparatus at E7.5 and E8.5. The particles were reduced in diameter at E13.5 and reduced in number at E18.5;-19. The data support the hypothesis that the yolk sac plays a vital role in providing lipids and lipid-soluble nutrients to embryos during the early phases (E7;-10) of mouse development. secretion in mouse yolk sac during embryonic development.
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Affiliation(s)
- Y Terasawa
- Gladstone Institute of Cardiovascular Disease, University of California, San Francisco, CA 94110, USA
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Abstract
UNLABELLED Survival advantage in Asian American end-stage renal disease patients. BACKGROUND An earlier study documented a lower mortality risk for end-stage renal disease (ESRD) patients in Japan compared with the United States. We compared the mortality of Caucasian (white) and Asian American dialysis patients in the United States to evaluate whether Asian ancestry was associated with lower mortality in the United States. METHODS The study sample from the U.S. Renal Data System census of ESRD patients treated in the United States included 84,192 white or Asian patients starting dialysis during May 1995 to April 1997, of whom 18,435 died by April 30, 1997. Patient characteristics were described by race. Relative mortality risks (RRs) for Asian Americans relative to whites were analyzed by Cox proportional hazards regression models adjusting for characteristics and comorbidities. Population death rates were derived from vital statistics for the United States and Japan by age and sex. RESULTS Adjusting for demographics, diabetes, comorbidities, and nutritional factors, the RR for Asian Americans was 0.75 (P = 0.0001). Race-specific background population death rates accounted for over half of the race-related mortality difference. For whites, mortality decreased as the body mass index (BMI) increased. For Asians, the relationship between BMI and survival was u-shaped. The ratio of Asian American/white dialysis death rates and the ratio of Asian American/white general population death rates both varied by age in a similar pattern. The population death rates of Asian American and Japanese were also similar. CONCLUSION Among dialysis patients, Asian Americans had a markedly lower adjusted RR than whites. The effect of BMI on survival differed by race. Compared with the respective general population, dialysis patients had the same relative increase in death rates for both races. The difference in death rates between the United States and Japan does not appear to be primarily treatment related, but rather is related to background death rates.
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Affiliation(s)
- J S Wong
- United States Renal Data System, University of Michigan, Ann Abor, USA
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49
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Hamilton RL, Moorehouse A, Lear SR, Wong JS, Erickson SK. A rapid calcium precipitation method of recovering large amounts of highly pure hepatocyte rough endoplasmic reticulum. J Lipid Res 1999; 40:1140-7. [PMID: 10357846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
We sought a rapid and non-ultracentrifugal method of recovering large amounts of highly pure rough endoplasmic reticulum (RER) membranes from livers. By substantially modifying a 20-year-old calcium precipitation technique, we obtained a RER fraction from rat liver and established its high degree of purity by quantitating classic membrane markers for different subcellular organelles. This RER fraction is highly enriched in four known proteins (or enzyme activities) required for lipoprotein assembly: apolipoprotein B, microsomal triglyceride transfer protein, acyl CoA:diacylglycerol acyltransferase, and acyl CoA:cholesterol acyltransferase, when compared to two classical RER markers, RNA and glucose-6-phosphatase. From one 10-12 g rat liver, we recover ten to twelve RER pellets of 1.5-1.6 cm in diameter containing approximately 110-125 mg of total protein, about half of which is sodium carbonate-releasable. By electron microscopy, these large RER pellets from rat livers are homogeneously comprised largely of non-vesiculated short strips of ribosome-rich membranes. This novel technique for isolating RER membranes from liver may provide a useful tool for future studies on the assembly of apolipoprotein B-containing lipoproteins as well as for research focused on mechanisms of secretory and membrane protein translation, translocation, and folding.
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Affiliation(s)
- R L Hamilton
- Cardiovascular Research Institute, University of California, San Francisco, CA 94143-0452, USA
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50
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Raabe M, Véniant MM, Sullivan MA, Zlot CH, Björkegren J, Nielsen LB, Wong JS, Hamilton RL, Young SG. Analysis of the role of microsomal triglyceride transfer protein in the liver of tissue-specific knockout mice. J Clin Invest 1999; 103:1287-98. [PMID: 10225972 PMCID: PMC408359 DOI: 10.1172/jci6576] [Citation(s) in RCA: 336] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A deficiency in microsomal triglyceride transfer protein (MTP) causes the human lipoprotein deficiency syndrome abetalipoproteinemia. However, the role of MTP in the assembly and secretion of VLDL in the liver is not precisely understood. It is not clear, for instance, whether MTP is required to move the bulk of triglycerides into the lumen of the endoplasmic reticulum (ER) during the assembly of VLDL particles. To define MTP's role in hepatic lipoprotein assembly, we recently knocked out the mouse MTP gene (Mttp). Unfortunately, achieving our objective was thwarted by a lethal embryonic phenotype. In this study, we produced mice harboring a "floxed" Mttp allele and then used Cre-mediated recombination to generate liver-specific Mttp knockout mice. Inactivating the Mttp gene in the liver caused a striking reduction in VLDL triglycerides and large reductions in both VLDL/LDL and HDL cholesterol levels. The Mttp inactivation lowered apo B-100 levels in the plasma by >95% but reduced plasma apo B-48 levels by only approximately 20%. Histologic studies in liver-specific knockout mice revealed moderate hepatic steatosis. Ultrastructural studies of wild-type mouse livers revealed numerous VLDL-sized lipid-staining particles within membrane-bound compartments of the secretory pathway (ER and Golgi apparatus) and few cytosolic lipid droplets. In contrast, VLDL-sized lipid-staining particles were not observed in MTP-deficient hepatocytes, either in the ER or in the Golgi apparatus, and there were numerous cytosolic fat droplets. We conclude that MTP is essential for transferring the bulk of triglycerides into the lumen of the ER for VLDL assembly and is required for the secretion of apo B-100 from the liver.
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Affiliation(s)
- M Raabe
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94141-9100, USA
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